Many Chest X-Rays in Children Are Unnecessary

Researchers found that in some children who received chest X-rays, the screening may have been unnecessary and offered no clinical benefit. In addition, approximately 88% of pediatric X-rays for chest pain included in the study did not alter clinical treatment.

The new findings were presented December 3, 2014, at the annual meeting of the Radiological Society of North America (RSNA), held in Chicago (IL, USA). “Chest X-rays can be a valuable exam when ordered for the correct indications,” said Ann Packard, MD, a radiologist at the Mayo Clinic (Rochester, MN, USA). “However, there are several indications where pediatric chest X-rays offer no benefit and likely should not be performed to decrease radiation dose and cost.”

Dr. Packard and coauthor, Kristen B. Thomas, MD, head of the pediatric division at Mayo Clinic and assistant professor of radiology at Mayo Medical School, reviewed data from 718 pediatric chest X-ray exams ordered between 2008 and 2014 in Mayo Clinic’s inpatient, outpatient and emergency room settings. The patients undergoing the exams ranged in age from newborn to 17 years old.

Of the 718 radiographs, 377 exams were ordered for chest pain, 98 indicated syncope (fainting) or presyncope, 21 indicated spells (a general feeling of being unwell or under distress), 37 indicated postural orthostatic hypotension (POTS), and 185 indicated dizziness. Eighty-two of the 718 exams were excluded due to congenital or other known heart disease, and other causes. The researchers discovered that in approximately 88% of the 330 non-excluded patients who presented with chest pain, the exam did not alter clinical treatment.

None of the patients who underwent X-rays for indications including syncope, spells, POTS, or dizziness had any finding that affected treatment. Thirty-eight of the 330 non-excluded X-rays for chest pain were positive for pneumonia, bronchial inflammation, trauma, or other conditions. “Approximately 12% of the chest X-rays for chest pain were positive and included respiratory symptoms such as cough, fever or trauma,” Dr. Packard said. “There were no positive findings in any chest X-ray for syncope, dizziness, spells, cyclical vomiting, or POTS for the past five years, even in our tertiary care center with referrals for rare diseases or unusual presentations.”

Optimizing radiation exposure and cost effectiveness are important topics in the current healthcare environment, particularly in a pediatric population, Dr. Packard noted. “This study addresses both of these issues, which is important not only for physicians but also for young patients and their parents,” she said. “I would like this research to help guide clinicians and deter them from ordering unnecessary exams which offer no clinical benefit to the patient.”

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